Sex and Gender Influence on Cardiovascular Health in Sub-Saharan Africa: Findings from Ghana, Gambia, Mali, Guinea, and Botswana

• Published in: Global heart 2022-09, Vol.17 (1), p.63
• Main Authors: Dev, Rubee, Favour-Ofili, Divine, Raparelli, Valeria, Behlouli, Hassan, Azizi, Zahra, Kublickiene, Karolina, Kautzky-Willer, Alexandra, Herrero, Maria Trinidad, Pilote, Louise, Norris, Colleen M
• Format: Article
• Language: English
• Subjects: Adult; Botswana - epidemiology; cardiovascular diseases; Cardiovascular Diseases - epidemiology; cardiovascular health; Female; Gambia; gender; Ghana - epidemiology; Guinea; Health Status; Humans; Hypertension - epidemiology; Male; Mali; Obesity - epidemiology; Original Research; Overweight; Risk Factors; sex; sub-saharan africa
• ISSN: 2211-8179; 2211-8160; 2211-8179
• DOI: 10.5334/gh.1146

There is an upsurge of cardiovascular diseases (CVDs) in sub-Saharan Africa (SSA). Irrespective of biological sex, gender-related factors could be the precursor of these conditions. To examine the associations between biological sex, gender-related variables, and cardiovascular health (CVH) risk factors in SSA countries. We used data from the STEPwise approach to surveillance of risk factors for non-communicable disease survey, conducted in adults from Ghana, Gambia, Mali, Guinea, and Botswana. The main outcome was CVH, measured through the health index with values ranging from 0 (worst) to 5 (best or ideal) CVH. Multivariable logistic regression was applied to determine the gender-related factors related to poorer CVH (index less than 4). Data included 15,356 adults (61.4% females, mean age 36.9 years). The prevalence of hypertension (21.6% vs. 13.8%) and overweight/obesity (48.3% vs. 27.5%) was higher among females as compared to males. Females were more likely to be unemployed (17.3% vs. 9.7%) or reported unpaid work (36.8% vs. 15.2%). Overall, females showed worse CVH than males (OR = 0.95, 95% CI:0.91-0.99). Being married was associated with better CVH compared with being single, more so for males (OR = 1.09, 95% CI:0.96-1.24, p < 0.01). Males with unpaid work (OR = 1.28, 95% CI:1.12-1.47) had better CVH than their unpaid female counterparts (OR = 1.08, 95% CI:1.01-1.17). In SSA populations, being female was associated with poorer CVH given the disproportionate burden of hypertension and overweight/obesity. Gender-related factors such as marital status and unpaid work were associated with better CVH in males compared to females.